“Every shoulder is different”: A qualitative study of clinicians’ insights on the causative factors and strategies of managing work-related shoulder disorders among firefighters

BACKGROUND: Work-related shoulder disorders (WSDs) are the third most prevalent work-related musculoskeletal disorder in firefighting, a significant occupational health concern among firefighters (FFs). However, comprehensive understanding of clinician perspectives on causative factors and evidence-based management strategies remains limited. OBJECTIVE: To explore clinicians' perspectives on: (a) the underlying causative factors contributing to WSDs; and (b) management strategies specific to firefighters. METHODS: Semi-structured interviews were conducted with 15 clinicians (11 males, 4 females) between 30-61 years of age, who had experience managing firefighters with WSDs. Data collection and analysis followed interpretive description methodology, employing iterative thematic analysis to identify recurring themes and patterns. RESULTS: Eight themes emerged: 1) The Nature of Firefighting Work Exacerbates Shoulder Injuries; 2) Work-Related Slips and Falls are Linked to Traumatic Shoulder Injuries; 3) Unequal Shoulder Injury Pattern by Sex and Work Experience; 4) Lack of Formal and Targeted Training Exercises Predisposes to Shoulder Injuries; 5) Early Diagnosis is Crucial for Effective Shoulder Management; 6) Individualized Multimodal Treatment Approaches are Key to Optimal Recovery; 7) (Re-)Education on Safe Exercise Training Minimizes Shoulder (Re-)Injuries; 8) Specialized functional Assessment and Outcome Measures could Enhance Treatment Outcomes. CONCLUSION: Firefighter WSDs are multifactorial, exacerbated by occupational exposures, sociodemographic factors and delayed or non-specialized care. Clinicians emphasize the need for implementing targeted functional rehabilitation approaches that consider the unique physical and operational demands of firefighting duties.